The 4,500 scientific abstracts presented here covered new prevention technologies, pre-exposure prophylaxis, new harm-reduction ideas, and collaborative research into an HIV-preventive vaccine, Dr. Cahn told the closing session of the six-day meeting.

Dr. Cahn is the incoming president of the International AIDS Society, the first from a developing nation to hold the office.

He was not alone in lauding the quality of the science. Sharon Walmsley, M.D., of Toronto's University Health Network, said, "I want to lay to rest the idea that there's no science at this meeting."

Dr. Walmsley was one of the co-chairs of a marathon session of late-breaking research, in which 18 studies were reported in the clinical science track alone. The conference divides its science into five tracks -- basic science, clinical science, epidemiology, social science and economics, and policy.

Among the reports:

Results of the first head-to-head study of the two main HIV regimens recommended for treatment-naÃ¯ve patients. Both are highly potent, the study found, but a regimen based on Sustiva (efavirenz) has the edge.

Details of a rapidly fatal outbreak of extensively drug-resistant (XDR-TB) tuberculosis in South Africa. The disease, resistant to all first- and second-line TB drugs, has killed all but one of the people infected.

Reports on new classes of HIV drugs, including integrase inhibitors that block the third step in the HIV life cycle and two types of compounds that block the cell-surface proteins that the virus uses as entry points.

But not all was science. The conference opened with a concert by the pop group Barenaked Ladies and singer Alicia Keyes. Former president Bill Clinton teamed up with Microsoft billionaire Bill Gates for a face-to-face chat about how their respective foundations are tackling the AIDS pandemic. Actor Richard Gere was part of a special session on the media and AIDS.

And Brazilian artist Adriana Bertini unveiled a line of evening wear made entirely of condoms.

One pink bodice took 245 hours and 3,600 condoms to make, although that pales before the 80,000 condoms she once used to make a wedding dress, Bertini told reporters. The condoms she uses are either defective or past their expiration date.

On another latex note, the United Nations Population Fund said that -- while condoms are the simplest and most basic HIV preventive measure -- they're not available to millions of people in the developing world.

"While we applaud discussion and research into new technologies, we are still not using what we have available today," said Steve Kraus, chief of the agency's HIV branch. He said almost 10 million condoms are used every year in low- and middle-income countries -- less than half what's needed.

The conference was told that treatment in the developing world has expanded dramatically in the wake of the World Health Organization's 3X5 program, which aimed at treating three million people by the end of 2005.

The program failed to reach its goal, but one in four of the people who most need treatment is now getting it, according to Kevin De Cock, M.D., director of WHO's department of HIV/AIDS. Of the 38.6 million people with HIV worldwide, about 6.8 million in low and middle income countries require therapy, Dr. De Cock said.

But by the end of June, WHO estimated that about 1.65 million were getting treatment, or about 24% of those in need. Dr. De Cock said the figures still represent "a predominantly empty glass" but they are also a sign that access to medication is increasing.

In contrast with the 2004 Bangkok AIDS conference -- where American programs and intentions were regarded with suspicion and anger -- the President's Emergency Program for AIDS Research (PEPFAR) was rarely spoken of here except as a shining example.

Although the $15-billion, five-year program was criticized for what some see as a moralistic agenda -- promoting abstinence and fidelity as the key elements in preventing HIV infection -- the predominant view was that most of the money is being well-used in places where it is desperately needed.

But while PEPFAR is generous now at $3 billion a year, it is an increasingly small proportion of the money that's needed, said Stephen Lewis, the UN special envoy for HIV/AIDS in Africa.

If it is renewed in 2008 at the same level, Lewis said, it will be a "pretty paltry" percentage of the $22 billion that experts estimate will be needed that year for global AIDS programs.

The conference ended with a "guarded optimism" that progress is being made, Lewis said, but controlling the pandemic depends on ensuring social justice, including equality for women, who are now bearing the brunt of HIV/AIDS in the developing world.

"Gender inequality is driving this pandemic," he said, "and we will never subdue the gruesome force of AIDS until the rights of women become paramount in the struggle."

Protest here, while noisy on occasion, was more subdued than at previous meetings. During the late-breaking science sessions, activists silently held up a banner criticizing the ethics of one African study, but did not interrupt the presentation.

And U.S. officials found a warmer welcome, contrasting with 2002 in Barcelona, for instance, when Tommy Thompson, the former secretary of health and human services, was booed so relentlessly he was unable to deliver his talk.

Here, the senior U.S. government scientist was Anthony Fauci, M.D., head of the national Institute of Allergy and Infectious Diseases, and -- true to form -- protesters disrupted his presentation at a plenary session.

But the highly respected Dr. Fauci wasn't the target. Instead, the protesters urged President Bush to "listen to Tony" about HIV/AIDS. Then, after three minutes, they left the stage and let Dr. Fauci get on with his talk.

For Toronto, the conference was a tourism boon. Hard-hit by another medical emergency -- the SARS outbreak in 2002 -- Toronto welcomed the 26,000 attendees and their wallets with open arms.

Operators of the city's popular Hippo Tours -- amphibious vehicles that tour the city before driving into Lake Ontario -- say they had to add extra trips because of the conference.

Restaurants and stores in Toronto's gay district, a few blocks from the convention center where the meeting was held, stayed open extra hours to accommodate the visitors.

And even the hot dog sellers made a killing. The conference has been "very good for us," said Elena Mintcheva, who runs a midtown wiener stand.

Reviewed by Zalman S. Agus, MD Emeritus Professor at the University of Pennsylvania School of Medicine

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